Dental Framework and Prosthesis

ABSTRACT

A dental prosthesis and a process for design and manufacturing, incorporating a dental implant framework and veneering overlay that will be designed and manufactured simultaneously and permanently fixated to one another.

CROSS-REFERENCE TO RELATED APPLICATIONS

Ser. No. 14/272,566 May, 2014 Schuler, et al.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not Applicable

REFERENCE TO SEQUENCE LISTING, A TABLE, OR A COMPUTER PROGRAM LISTINGCOMPACT DISC

Not Applicable

AMENDED DESCRIPTION Field of the invention

Dentists are continuously searching for methods in which they canprovide aesthetic and durable prostheses for their patients. One of thegreatest challenges they face are providing a restoration that willresist the occlusal forces in a reduced vertical restorative dimensionwhile obtaining a high level of aesthetics. Dentists are also lookingfor a cost effective and time efficient manner in which to obtain thisresult. In application Ser. No. 14/272,566, the Inventor demonstrated anovel dental prosthesis with an implant framework supporting a series ofcrowns/bridges to provide improved aesthetics and functionality. In oneof the embodiments of the invention, the crowns were united togetherinto a bridge due to limitations of the case or for personal preferenceby the dentist or technician. This bridging provides significantadvantages for cases where there is limited restorative space. Thisapplication will disclose a new dental prosthesis and design method thatprovides advantages over current systems and products in the marketplace and address the challenges of limited restorative space.

Amended Background of the Invention

This application is a divisional of U.S. patent application Ser. No.15/068423 filed Mar. 11, 2016, which was a continuation in part of U.S.patent application Ser. No. 14/272,566 filed May 8, 2014. The benefit ofthe earlier filing dates of the aforementioned U.S. patent applicationSer. No. 15/068,423 and U.S. patent application Ser. No. 14/272,566 arehereby claimed.

Traditional acrylic processed dental hybrid restorations utilize amilled or cast framework/bar where individual denture teeth are retainedto the framework by processed acrylic. This process requires a highlevel of skill and significant time in the laboratory. Many times due tothe limited restorative space, these traditional hybrids break andfracture due to the occlusal forces of the patient exceeding thestrength of the acrylic. With the introduction of a dental prosthesisconsisting of a dental implant framework supporting a series ofindividual crowns/bridges, the occlusal loads can be transferred throughthe crown and directly into the supporting framework and dentalimplants. This individual crown prosthesis has noted improvedperformance and avoids potential breakdown of the acrylic. However thereare instances especially in cases with limited restorative space, wherethe individual crown prosthesis would not be an ideal option due to thespace required for the underlying framework and appropriate wallthickness of crowns. This application will disclose an improved dentalprosthesis and design process that will provide improved performance inthese spatially limited cases while still achieving the necessaryaesthetics for the Dentist and their patients. This application willalso disclose a unique CAD subtract body that will be unique in thecreation of the dental prosthesis.

In U.S. patent application Ser. No. 14/272,566 Schulter et al. teaches adental prosthesis consisting of crowns and a dental implant frameworkintended to mate to a series of implants/abutments.

In U.S. Pat. No. 8,100,692 Diagenlo, et al., teaches a dental frameworkthat is attached to dental anchors, such as dental implants which aresecured to the patient's mandible or maxilla, where the framework may befabricated based on the dimensions and surface contours of a stone castand diagnostic wax up created from an impression of the patient's mouth.

In U.S. patent application Ser. No. 11/876,450 Karlsson teaches of theutilization of a dental scanning unit commonly found in the marketplace.

AMENDED SUMMARY OF THE INVENTION

In accordance with the first embodiment of the invention, a dentalprosthesis is disclosed consisting of a veneering overlay and dentalimplant framework intended to mate to a series of implants/abutments ina patient's mouth. The veneering overlay and dental implant frameworkare designed on the basis of digital data defining the appropriate toothcontours, gingiva contours, and implant locations. The dental implantframework consists of a series of mating cylinders, support posts. Theveneering overlay duplicates the anatomy provided in the digital datadefining the appropriate tooth position and gingiva contours of thefinal prosthesis. The veneering overlay and dental implant framework aredesigned simultaneously and with a predefined mating surface andclearance gaps to ensure the appropriate mating of the veneering overlayto the dental implant framework. The unique mating surface is createdthrough a unique CAD subtract body that is dependent upon the designfeatures of the dental implant framework. The veneering overlay anddental implant framework are permanently fixated to one another inproviding the completed dental prosthesis.

In accordance with the second embodiment of the invention, a dentalimplant framework is disclosed which is intended to mate to a veneeringoverlay and a series of implants/abutments in a patient's mouth. Thedental implant framework is designed on the basis of digital datadefining the appropriate tooth contours, gingiva contours, and implantlocations. The dental implant framework consists of a series of matingcylinders, support posts. The dental implant framework is designed witha predefined mating surface and clearance gaps to ensure the appropriatemating of the veneering overlay to the dental implant framework. Theunique mating surface is created through a unique CAD subtract body thatis dependent upon the design features of the dental implant framework.

In accordance with the third embodiment of the invention, a unique CADsubtract body is disclosed to create the mating surface for a veneeringoverlay and a dental implant framework. The veneering overlay and dentalimplant framework are designed on the basis of digital data defining theappropriate tooth contours, gingiva contours, and implant locations. Thedimension of the unique CAD subtract body are dependent upon thedimension of the dental implant framework. Some of the dimensions of theunique CAD subtract body are used in creating the mating surface for theveneering overlay to mate with the dental implant framework, where otherdimensions are used in creating clearance gaps between the veneeringoverlay and dental implant framework. The unique CAD subtract body isfully parametric and can be updated per the unique requirements of thepatient, dentist, or technician.

AMENDED BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

FIG. 1 is a fragmentary perspective view of a patient's open mouth withthe anchors embedded in the patient's mandible;

FIG. 2 is a fragmentary perspective view of the patient's open mouthwith several copings attached to the anchors and an impression tray withimpression material surrounding the patient's mucosal tissue andsubmerging the copings;

FIG. 3 is a perspective view of the impression of FIG. 2 inverted andremoved from the patient's mouth with two analogs attached to two of thecopings;

FIG. 4 is the same perspective view of FIG. 3, but with analogs attachedto all the copings, and the impression filled with dental stone materialand the analogs submerged in the dental stone material;

FIG. 5 is a perspective view of the stone cast formed by the dentalstone material poured in the impression of FIG. 4 in its hardened state,inverted, and with the impression removed showing the analogs with theanalog surfaces that mated with the copings (in FIG. 4) now exposed;

FIG. 6 is a perspective view of the stone cast of FIG. 5 with thedentist's fabricated diagnostic wax-up built up on the stone cast andabutting the analogs;

FIG. 7 is a cross-sectional view of the stone cast of FIG. 6 taken atsection line 7-7 in FIG. 6;

FIG. 8 is a perspective view of the stone cast of FIGS. 5-7, with aputty index molded to the facial aspect of the diagnostic wax-up;

FIG. 9A is a cross sectional view of the stone cast of FIGS. 5-8 takenat section line 9-9 in FIG. 8;

FIG. 9B is a cross sectional view of the stone cast of FIGS. 5-8 withthe diagnostic wax-up removed to show the inner surface of the puttyindex and the impression of the facial aspect of the diagnostic wax-upformed on the inner surface of the putty index;

FIG. 10A is a perspective view of the stone cast of FIGS. 5-9B with sixfittings, one fitting attached to each of the six analogs;

FIG. 10B is a perspective view of the bridging structures fixed to andbetween each of the six fittings to form a wax-up framework mounted onthe six analogs;

FIG. 11A is a flow chart demonstrating the steps necessary forfabricating a framework to receive individual crowns through a“copymill” procedure;

FIG. 11B is a flow chart demonstrating the steps necessary forfabricating a framework through a “copymill” procedure for a traditionalacrylic processed hybrid utilizing individual denture teeth;

FIG. 12A is a flow chart demonstrating the steps for the process indesigning and fabricating a dental prosthesis composing of an implantframework and series of crowns/bridges per patent application Ser. No.14/272,566;

FIG. 12B is a flow chart demonstrating the steps for the new inventedprocess and invention;

FIG. 13 is a schematic diagram of the scanner and the wax-up frameworkand alignment posts that it is scanning;

FIG. 14A is a front view of the graphical representation of the surfacemodel scanned from the denture tooth;

FIG. 14B is a side view of the graphical representation of the surfacemodel scanned from the denture tooth;

FIG. 15A is a front view of the graphical representation of the crownand support post/prep tooth form models;

FIG. 15B is a side view of the graphical representation of the crown andsupport post/prep tooth form models;

FIG. 15C is a cross sectional view of the crown and support post/preptooth form models of FIG. 15B taken at section line C-C in FIG. 15A;

FIG. 15D is a cross sectional view of the crown and support post/preptooth form models of FIG. 15A taken at section line D-D in FIG. 15B;

FIG. 15E is a perspective view of the crown and support post/prep toothform models demonstrating their alignment separate from one anotherpossessing independent coordinate systems;

FIG. 15F is a perspective view of the crown and support post/prep toothform models aligned correctly relative to one another and showing theirindividual coordinate systems aligned correctly to one another;

FIG. 15G is a cross-sectional view of a crown and support post/preptooth form model and demonstrates the feature dependency created betweenthe crown and support post/prep tooth form models, where the cement gapand margin have been automatically updated based upon the supportpost/prep tooth form being positioned higher;

FIG. 15H is a cross-sectional view of a crown and support post/preptooth form model and demonstrates the feature dependency created betweenthe crown and support post/prep tooth form models, where the cement gapand margin have been automatically updated based upon the supportpost/prep tooth form being angulated to a new orientation;

FIG. 16A is a graphical representation of diagnostic wax up surfacemodel with one of the crown and support post/prep tooth form assembliesappropriately aligned;

FIG. 16B is a graphical representation of diagnostic wax up surfacemodel with all of the crown and support post/prep tooth form modelsappropriately aligned;

FIG. 17 is a graphical representation of the support posts/prep toothforms in their appropriate alignment based upon the diagnostic was upsurface model;

FIG. 18 is a graphical representation of the DPF's and supportposts/prep tooth forms appropriately positioned relative to one anotherin creating the surface model of the framework;

FIG. 19A is a perspective view of the surface model of the frameworkwith the DPF's, support posts/prep tooth forms, and bridging structuresappropriately positioned relative to one another;

FIG. 19B is a top view of the surface model of the framework with theDPF's, support posts/prep tooth forms, and bridging structuresappropriately positioned relative to one another;

FIG. 20A is a perspective view of the surface model of the frameworkincluding DPF's, support posts/prep tooth forms, and bridging structureswith the crown models appropriately positioned;

FIG. 20B is a top view of the surface model of the framework includingDPF's, support posts/prep tooth forms, and bridging structures with thecrown models appropriately positioned;

FIG. 21 is a side view of the bridge model;

FIG. 22 is a side view of the framework model with a PTF bridgingstructure;

FIG. 23A is a side view of the framework model with the associatedbridge model appropriately aligned together;

FIG. 23B is a top view of the framework model with the associated bridgemodel appropriately aligned together;

FIG. 24A is a perspective view of the framework designed to support theveneering overlay; FIG. 24B is a side view of the framework designed tosupport the veneering overlay;

FIG. 25A is a back side view of the framework and the veneering overlayappropriately aligned and mating with one another;

FIG. 25B is a bottom side view of the framework and the veneeringoverlay appropriately aligned and mating with one another;

FIG. 25C is a perspective view of the framework and the veneeringoverlay appropriately aligned and mating with one another;

FIG. 25D is a cross-sectional view of the framework and the veneeringoverlay appropriately aligned and mating with one another;

FIG. 25E is a second cross-sectional view of the framework and theveneering overlay appropriately aligned and mating with one another anddemonstrating the cement gap pertaining to the protrusion on the topsurface of the framework;

FIG. 26A is a perspective view of the framework, the veneering overlay,and crown appropriately aligned and mating with one another;

FIG. 26B is a perspective view of the framework and the veneeringoverlay appropriately aligned and mating with one another and with thePTF of the framework extending through the veneering overlay;

FIG. 26C is a cross-sectional view of the framework, the veneeringoverlay, and crown appropriately aligned and mating with one another,with the crown mating to the PTF associated with the framework;

FIG. 26D is a perspective view of the framework and the veneeringoverlay appropriately aligned and mating with one another and with thePTF as part of the veneering overlay; and

FIG. 26E is a cross-sectional view of the framework, the veneeringoverlay, and crown appropriately aligned and mating with one another,with the crown mating to the PTF associated with the veneering overlay.

AMENDED DETAILED DESCRIPTION OF THE INVENTION

The dental prosthesis is supported by a dental framework which functionsas a structural support and point of attachment. The dental framework isattached to dental anchors, such as dental implants which are secured tothe patient's mandible or maxilla, the framework may be fabricated basedon the dimensions and surface contours of a stone cast and diagnosticwax up created from an impression of the patient's mouth such asdescribed in U.S. Pat. No. 8,100,692. The stone cast replicates the softtissue contours and implant positions in the patient's mouth. Thediagnostic wax up represents the final prosthesis and ultimately theposition of the denture teeth to be restored for the patient. In orderto create the diagnostic wax up, the dentist or technician will positionupon the stone cast the stock denture teeth and wax as required forproper prosthetic function and aesthetics. The commercially availablestock teeth are generally manufactured with predetermined geometries ofa typical given tooth in various sizes by a third-party manufacturer.

Retention of the dental prosthetic requires anchors secured in thepatient's mouth. In FIG. 1, the patient's jaw or mandible 100 can beseen overlaid with soft mucosal tissue 102 (For the purposes of thisdescription, the inventor will be utilizing the term mucosal tissue orsoft tissue to describe any of the soft tissue found in the oral cavity,which may include but not limited to mucosal, gingiva, or alveolartissue.). An anchor 104, also known as an “implant” or “fixture” isshown embedded into the patient's mandible 100. This anchor is retainedwithin the bone of the mandible by a screw thread. It is driven into themandible 100 by coupling a wrench or similar device to the top of theanchor 104 and rotating the wrench to drive the anchor into the jaw bonejust as one would drive a screw into a piece of wood. In an alternativeembodiment, the anchor 104 is press fitted into a hole formed with adrill, reamer, broach, osteotome, or similar device.

FIG. 1 illustrates the first step in the process, that of forming anopening in the mandible of the patient and fixing an anchor therein,while leaving a top surface of the anchor exposed above mucosal tissue102 for mating (coupling) to and supporting a dental prosthesis orrestorative component such as a denture, bridge, crown, framework,abutment, healing cap, or coping (hereinafter referred to as “denture”).Note that while the process illustrated herein describes and illustratesa mandible for illustration purposes, the same process is performed toembed anchors 104 into the patient's maxilla and create dentalprostheses for the maxilla.

To attach anchors 104, the dentist first makes an incision in themucosal tissue 102 where a missing tooth or teeth would normally extendfrom the mandible where it is embedded, through the gum, and into theoral cavity. Once the incision is made, the dentist makes a hole (whichmay include such processes as drilling, broaching or reaming) in themandible 100 in the same general direction and location as the missingtooth. The dentist then fixes an anchor 104 into the hole thus createdand sutures the incision, typically leaving mating surface 108 of anchor104 exposed while the bone osseointegrates to the outer surface ofanchor 104. Alternatively, the dentist may attach a healing cap to theanchor 104 and suture the gum around or over the top of the anchor 104and the healing cap, permitting the gum to heal around or over the topof the anchor 104 as it osseointegrates. In this alternative process,once the anchor has osseointegrated, the dentist incises the mucosaltissue 102 extending over the top of the now-integrated anchor 104 andretracts the mucosal tissue to each side, exposing the mating surface108 of anchor 104 and permitting the mucosal tissue to heal.

The anchor 104 has a central longitudinal aperture 107 in the top whichis configured to receive an impression coping 110, as shown in FIG. 2,(or a fastener configured to mount the impression coping 110) that isaffixed to the anchor 104. This coping transfers the size, shape,location or orientation of the mating surface 108 of the anchor (andpreferably all four) to the stone cast (see below). It is the matingsurface 108 that is oriented to the finished denture, and hence themating surface 108 from which the structures of the denture that mountto the anchors are derived. In general, anywhere from one to twelve ofthese anchors are embedded in the jaw and are provided as mountingpoints for the denture. In an alternative configuration, anchor 104 mayhave a variety of configurations on its mating surface 108 includingthreaded or unthreaded protrusions or recesses that are configured toengage a denture. The use of an anchor 104 having a central aperture andinternal threads for engaging a coping is a matter of convenience hereinand should not suggest that the process is limited to an anchor havingthis configuration.

Mating surface 108 is typically the surface on which the denture will bemounted or a surface having a predetermined position with respect tothat surface on which the denture will ultimately be mounted. The coping110 is configured to engage surface 108 and surrounding structures ofanchor 104 (if any) such as holes that extend into (or protrusions thatextend above) the surface 108.

These inter engaging surfaces of coping 110 and anchor 104 serve toalign the coping and the anchor in predetermined positions with respectto each other when fixed together, such that if one knows the positionand orientation of surfaces on the coping one can know the position andorientation of corresponding structures on the anchor 104 and morepreferably when a scanner (see below) determines the position andorientation of structures on copings 110 it can mathematically determinethe position and orientation of corresponding structures on anchors 104.Anchor 104 is preferably cylindrical and has a longitudinal axis 111, asdoes coping 110. In a typical arrangement, when the coping 110 is fixedin its predetermined position with respect to anchor 104, a longitudinalaxis 111 of the coping is coaxial with the longitudinal axis of theanchor 104. The coping 110 and the anchor 104 are preferably threadedlyengaged to permit surfaces on the coping to be drawn down tightlyagainst mating surface 108 for precise alignment of their inter engagingsurfaces. Alternatively, the coping 110 and anchor 104 to which it iscoupled may be equipped with inter engaging snap fastening connectingsurfaces that hold the coping in the proper orientation with respect toanchor 104.

In FIG. 1, the edentulous mandible 100 has six anchors 104 affixedtherein in a spaced-apart relation extending from the front of mandible100 around each side. The anchors 104 are disposed in a generallyupright and parallel relation extending into the top surface of mandible100. The dentist attaches corresponding copings 110 to the top of eachanchor 104 and extends upward in a generally upright and parallelrelation to the other copings 110. The application illustrated hereinshows the use of six anchors configured to support a denture. Otherapplications with more or fewer anchors 104 are possible. Furthermore,the mandible need not be edentulous (shown here), but may have, andoften does have, one or more natural teeth remaining in the maxilla ormandible between which the anchors 104 are embedded to support one ormore dentures (such as fixed or removable partial dentures) to fill thegap or gaps between the existing natural teeth. In this case, theanchors would not be spaced evenly about the mandible, as shown here,but would be spaced irregularly in the gaps created by the absence ofnatural teeth.

FIG. 2 illustrates the next step in the process of creating a denture,the step of creating an impression of the patient's mandible. Thisfigure shows an impression tray 120 filled with flexible impressionmaterial 122. The tray is a semi flexible plastic structure that holdsthe impression material 122 in position around the patient's teeth (ifany) and mucosal tissue. FIG. 2 shows a tray 120 for the lower teethsurrounding teeth, mucosal tissue, and mandible of the patient.

The copings 110 previously attached by the dentist to the anchors 104are completely submerged by the dentist in impression material 122 suchthat the entire outer surfaces of the copings 110 extending above thesurface of the mucosal tissue on the patient's mandible 100 arecompletely covered. The impression material is left in this position toset. Once set, the individual copings 110 are fixed with respect to eachother in the same position and orientation that the anchors 104 arefixed with respect to each other. The curing process fixes the copingsin this position and thereby permits the copings to be collectivelyremoved together with the impression material while preserving theirorientation.

In the next step of the process, the dentist flexes the tray 120 and thenow set impression material 122 and removes them from the patient'smouth. Enough impression material 122 is placed in the tray and disposedaround the patient's mandible 100 to cover any still-existing teeth ofthe mandible and the mucosal tissue 102 of the mandible as well as thecopings 110.

When the tray 120 and impression material 122 are removed, the copingsare removed with them, embedded in the now-cured impression material122. The process of removal disconnects the copings 110 from the anchors104, permitting the copings to be removed while still embedded in theimpression material 122. If the copings include a threaded portion thatholds them to the anchors, this threaded portion is unthreaded from theanchors. If the copings are fastened to the anchors with a snapfastening portion, the snap fastening portions are unsnapped from eachother.

The now-cured impression material 122 that couples the copings 110 toeach other preserves the relative positions and orientations of themating surfaces of all the copings 110 and hence relative positions andorientations of the mating surfaces 108 of all the anchors 104 withrespect to each other. This relationship is preserved in the relativepositions and orientations of the surfaces of copings 110 that wereconnected to the mating surfaces 108 of anchors 104. To even furtherensure the preservation of this relationship, some dentists will attachthe copings 110 to one another by applying a light cured acrylicmaterial prior to submerging them in the impression material 122. Theimpression material 122 in which copings 110 are embedded also preservesthe surface contours of the mucosal tissue and the remaining teeth (ifany) in the mandible and their relative positions with respect to themating surfaces of copings 110 and anchors 104. The surface of theimpression material 122, once removed from the patient's mouth, is anegative replica of the soft tissue and teeth. The surfaces of copings110, now separated from anchors 104 and exposed on the inside surface ofthe impression material 122, are a negative replica of surfaces 108 ofanchors 104 to which they were coupled. The now-cured impressionmaterial 122 is therefore a negative replica of all the free surfaces,including teeth, mucosal tissue, and the surfaces of the copingsembedded in the impression material are a negative replica of the matingsurfaces 108 of anchors 104. The cured impression material with embeddedcopings is commonly called an “impression” and identified in the figuresherein as item 123.

FIG. 3 shows the impression 123 inverted and removed from the patient'smouth. In this embodiment, there are six copings 110 embedded in theimpression 123. The bulk of the copings 110 are embedded in theimpression 123. Only the very ends of the copings 110 extend upward andout of the impression 123 (in this inverted orientation).

In FIG. 3 the dentist has begun the next step of the process, that ofattaching analogs 124 to the exposed surfaces of all of the copings 110.Analogs 124 are structures that replicate the anchors 104. As in thecase of the copings themselves, each analog 124 preferably comprises agenerally cylindrical body with a longitudinal axis 127 that is coaxialwith the longitudinal axis 111 when attached to coping 110.

The end surfaces of analogs 124 are configured to abut and mate with thefree surfaces of the copings 110 that were previously coupled to anchors104 and normally attach in the same manner as copings 110 to anchors104. The surfaces of analogs 124 replicate the position and orientationof mating surfaces 108 of anchors 104. In effect, the spacing andorientation of anchors 104 was transferred to the copings 110, andtransferred back again to analogs 124, which have the same spacing andorientation as the anchors 104. Thus, each analog 124 is coaxial withand is disposed in the same position as anchor 104.

In the next step of the process, illustrated in FIG. 4, the dentistpours a mixed dental stone material 126 into the cavity in impression123 that was formed by the patient's mandible, submerging all of theanalogs 124. Stone material 126 covers the exposed portion of theanalogs 124 as well as the surfaces of impression 123 formed by thepatient's mucosal tissues and teeth. Once filled into impression 123,the stone material 126 is then permitted to harden to a rock-likeconsistency, creating a structure that is called a “stone cast” 125.

FIG. 5 represents the next step of the process which the dentistperforms once the stone material 126 has hardened. The dentist removesimpression 123 from the stone cast 125, leaving the stone cast 125 withthe analogs embedded therein. The stone cast 125 positively replicatesthe position and orientation of mating surfaces 108 of anchors 104,which are represented in the stone cast 125 by the mating surfaces 128of the analogs 124 that were fixed to the free ends of copings 110 (FIG.

3). The portions of the stone cast 125 surrounding analogs 124positively replicates the surface of the mucosal tissues of the mouth,which were transferred from the mucosal tissues of the mouth to theimpression as a negative replica and then back to the stone cast as apositive replica of those tissues. The stone cast 125 also replicatesthe surface of the patient's existing teeth (not shown). When thepatient has existing teeth, the position and orientation of the surfacesof the teeth are transferred first to the impression as a negativereplica and then to the stone cast as a positive replica. In the presentembodiment, the mandible 100 is edentulous and therefore there are noexisting teeth.

As will be explained later, teeth that are replicated in impression 123and stone cast 125 provide a precise reference to indicate the locationof the jawbone. The soft tissues that are replicated in the impression123 and stone cast 125 can change their position due to swelling, edema,injury, irritation, or damage to the mouth. Teeth, since they are muchharder and are embedded in the jawbone, provide a more stable reference,over time, of the position of the jawbone and thus indirectly, of theposition and orientation of anchors 104.

The impression molding and stone casting processes described aboveprovide accurate replicas of the position and orientation of the matingsurfaces 108 of anchors 104, the mucosal tissues, and the teeth.

In the preferred embodiment, the mating surfaces 108 of anchors 104 areexactly duplicated by the mating surfaces 128 of the analogs 124: theyare in exactly the same position and at exactly the same orientation. Inan alternative embodiment, the mating surfaces 128 on the analogs may beoffset slightly or configured slightly differently than the matingsurfaces 108 of anchors 104. In some cases, manufacturers choose to makeanalogs or other connecting components that have mating surfacesslightly different from the mating surfaces 108 of the anchors 104 forexample to permit the copings 110 to be more easily attached to anchors104 or to permit analogs 124 to be more easily attached to copings 110.Any slight difference in position such as this is intentional, however,and is eliminated later in the process when the denture is created sothat the mating surfaces of the denture are precisely oriented to mateproperly with surfaces 108 of anchors 104 in the patient's mouth.

Further, the anchors 104 in the patient's mouth may not be connecteddirectly to the dental framework. Abutments may be mounted on theanchors 104 (i.e. the anchors have surmounted abutments). The dentalframework may be mounted to these abutments, and thus indirectly mountedto anchors 104. When the dental framework being designed is intended tobe mounted on abutments mounted on anchors 104, the analogs 124 may beprovided with surmounted abutments, i.e. the analogs may include theabutment design incorporated into it, to replicate the mating structureof the abutment to the framework.

While the mating surfaces 128 of the analogs 124 and the mating surfaces108 of anchors 104 may be slightly differently configured, thelongitudinal axes of each of the anchors 104 and the analogs 124 arepreferably identically oriented and spaced apart, each pair ofcorresponding analog and anchor sharing a common longitudinal axis (i.e.they are coaxial). Considered differently, if the surface of the stonecast representing the soft tissues and teeth of the patient's mouthcould be superimposed on top of the patient's mucosal tissues 108 thatformed the stone cast 125, all the longitudinal axes defined by theanalogs would be superimposed on (i.e. simultaneously coaxial with) allthe corresponding axes defined by the anchors. The longitudinal axes 127of the analogs 124 and the surfaces of the stone cast 125 defined by themucosal tissues 108 the patient are positive replicas of thelongitudinal axes 111 of anchors 104 and the surfaces of mucosal tissues108.

The replica of any teeth formed in the surface of the stone cast areformed with respect to one another and with respect to the analogs suchthat they duplicate the position of any existing real teeth in thepatient's mouth with respect to one another and with respect to matingsurfaces 108 and longitudinal axes of the anchors 104 in the patient'smandible. The replica of the mucosal tissues formed in the surface ofthe stone cast are in generally the same position on the stone cast asthey are in the patient's mouth including the replication in the stonecast 125 of the junction between the mucosal tissue and any existingteeth and anchors 104, as well as a replication in the stone cast of allthe mucosal tissue that will be covered by the denture.

Once the dentist has created the stone cast 125, which is a positivereplica of the patient's jaw, including replication of existing teeth,mucosal tissue, and anchors, the dentist then proceeds to the next stepin the process: designing and creating the denture that will be fittedto the patient's mouth (in this case, the patient's jaw).

The dentist or technician manually creates a diagnostic wax-up 130 ofthe desired denture teeth position and occlusal orientation, usingflexible molding materials such as wax, acrylic, or other polymers andstock denture teeth commonly found in the market. These stock dentureteeth are of a known dimension and have contours specific to the mold orcatalog number of the denture teeth. These denture teeth are also madefrom a combination of materials such as acrylic and composite. Thecomposite portion is typically used for the aesthetic upper portion ofthe denture tooth as the composite can provide the appearance oftranslucency. The lower portion of the denture tooth typically consistsof acrylic which is ideal in bonding to the processed acrylic for thedenture base or acrylic used in adhering the denture teeth to a milledor cast framework/bar for a traditional hybrid dental restoration. Thedentist or technician may also modify these denture teeth slightly inorder to provide the appropriate occlusal scheme to best fit anyexisting teeth or dental prosthesis on the opposing arch. Thesemodifications may include but are not limited to the addition ofocclusal contours by adding wax or the removal of occlusal contours bymodifying the surface with a bur and hand piece.

The diagnostic wax-up 130 is created to verify the proper location ofthe denture mucosal tissue and denture teeth with respect to thepatient's actual mouth to ensure proper tooth orientation, and to ensurethat the location and placement of the denture within the patient'smouth restores form, fit and function. In short, the diagnostic wax-up130 is a model of and looks like the denture that is ultimatelyproduced, but is made of softer materials to permit it to be adjustedand adapted until the patient and dentist are pleased with its form,fit, function and aesthetics.

The dentist creates the wax-up 130 on the stone cast 125, building it upon the patient's replica mucosal tissue. When the dentist is finishedmaking the wax-up 130, he removes the wax-up 130 from the stone cast125, and places it into the patient's mouth so the patient can see,firsthand, what the denture or prosthesis will look like when it isfinished. If the wax-up 130 fits, the patient can bite properly, and thepatient is pleased with the appearance of the wax-up 130, the dentistthen proceeds to manufacture the framework and resulting prosthesis.

FIGS. 6-7 illustrate the process of creating a wax-up, showing the stonecast 125 as it would appear with a wax-up 130 modeled on its outersurface. In FIG. 6, the stone cast 125 is shown covered with the wax-up130 which comprises the denture teeth 132 embedded in wax 134 which thedentist has molded directly to the surface of the stone cast 125. FIG. 7is a cross-sectional view through the stone cast 125 plus wax-up 130shown in FIG. 6. This cross-section is taken at section line 7-7 in FIG.6. Once the dentist has created the wax-up 130 and has verified thefitting of the wax-up 130 in the patient's mouth, he can then begin theprocess of having the framework fabricated for the patient.Traditionally these frameworks have been cast, but more recently it hasbecome common for these frameworks to be scanned and duplicated in anappropriate dental material (titanium, cobalt chrome, zirconia, plastic,PMMA, acrylic, etc. . . . ) by a common manufacturing method (milling,3D printing, laser sintering, EDM, etc. . . . )

The steps associated with the traditional “individual crown copymill”process are outline in flowchart 600 of FIG. 11A. As noted in STEP 604of Flowchart 600, the Dentist or technician will begin to fabricate anacrylic model of the framework that will be duplicated in a materialsuch as titanium, cobalt chrome, zirconia, or any other appropriatedental material. The first step in this process is creating a facial orputty index of the diagnostic wax-up 130 while positioned on stone cast125, which captures the facial/buccal contours of the denture teeth 132including their height and angulation and the soft tissue contours ofthe diagnostic wax up. FIGS. 8 and 9A-B illustrate the process ofcreating the facial index. FIG. 8 shows the facial index 142 as createdusing stone cast 125 and diagnostic wax up 130. This facial index 142 iscreated by wrapping a silicone putty material 144 commonly used in thedental industry around the facial/buccal aspect of the diagnostic wax up130 while it is properly positioned on stone cast 125. The facial indexwill engage a significant area of the stone cast 125 that is not coveredby diagnostic wax up 130. The facial index 142 will have a unique stonemating area 145 that will allow for the facial index to be properlypositioned back to stone cast 125 without the aid of diagnostic wax up130. FIG. 9A is a cross-sectional view through the facial index 142,stone cast 125, and diagnostic wax up 130, demonstrating the capturingof the buccal aspect of denture teeth 132. This cross-section is takenat section line 9-9 in FIG.8. Once the putty material 144 has set thefacial index 142 and diagnostic wax-up 130 can be removed from the stonecast 125. FIG. 9B shows the negative impressions 147 left by thefacial/buccal contours of denture teeth 132. The facial index 142 willbe placed back onto the stone cast 125 utilizing the unique stone matingareas 145. The dentist or technician will utilize facial index 142 as aguide to begin building the acrylic model of the intended framework. Asdemonstrated in FIG. 10A, wax copings or fittings 152A-F will beattached to the mating surface of the analogs 124 and begin stackingacrylic material 160 on top of them to begin forming the design. Theacrylic material 160 can be a light cured or cold cured resin commonlyused in dentistry. It can also be appreciated that materials other thanacrylic such as wax can be used in creating the design of the frameworkby the dentist or technician. Frequently the dentist of technician willutilize a hand piece and bur to reduce and refine the contour of theacrylic material 160 in order to create the necessary margins 162 andsupport posts 164 that the individual crowns will be intended to mate toon the framework. As shown in FIG. 10B, the support posts 164 will beattached to one another by bridging structure 154 that will run betweenfittings 152. The inventor is using the term support posts as adescriptive term in this application, but others may refer to thisframework feature as a pontic, abutment, prep tooth form or frameworkabutment. The support posts 164 will be designed in such a way as tosupport a crown that will be designed to mate to the margin 162 asdesigned into the framework. Depending upon the tooth type, the designof the support post 164 will be adapted per the dentist or technician tosupport the crown against the expected occlusal forces of the patient.

Once the acrylic model 166 of the framework is deemed acceptable thedentist or technician will send the acrylic model 166 and stone cast 125to a laboratory or framework supplier to have the acrylic modelduplicated in the material of their choosing. These STEPS 606, 608, and660 are noted in Flowchart 600 shown in FIG. 11A. The laboratory orframework supplier will scan the stone cast 125 to determine theorientation and location of the mating surfaces of analogs 124 and scanthe acrylic model 166 to capture the contours designed by the dentist orthe technician. Once an appropriate rendering of the acrylic model 166has been generated, a tool path will be generated for fabricating theframework out of the appropriate material. The laboratory or frameworksupplier can use a number of manufacturing methods, such as milling, 3Dprinting, laser sintering, ceramic pressing, EDM (electric dischargemanufacturing), etc. . . . , in a multitude of materials, such astitanium, zirconia, cobalt chrome, semi-precious metals, etc. . . . tofabricate the resulting framework. It can also be appreciated that thedentist or technician may also possess the scanning and/or fabricationequipment necessary to perform these tasks or a portion of these tasksinternally within their own facility.

Once the acrylic model 166 of the framework has been duplicated in theappropriate material the duplicate framework 168 and stone cast 125 arereturned to the dentist or technician. As noted in STEPS 662 and 664,the duplicate framework 168 is placed in the patient's mouth ontoanchors 104 and reviewed for fit and to ensure the duplicate framework168 has the appropriate contours necessary for the final prosthesis. Thedentist and technician may choose to alter some of the contours of theframework to better accommodate the necessary function, aesthetics andphonetics of the patient. These alterations can vary from reducing theheight of the support posts 164 or reducing a facial/buccal/lingualcontour of bridging structure 154 to reduce the potential of theprosthesis from extending into the cheek or tongue. Some dentists andtechnicians may elect to skip these steps.

As noted in STEPS 666-630, the dentist or technician can beginfabricating the crowns. The process outlined here in is in utilizationof dental scanning unit commonly found in the market place. Moredetailed information regarding this process can be found in patentapplication Ser. No. 11/576,450. The following information will onlybriefly cover the necessary steps associated with this process toprovide a general understanding and should not be considered a detailedoutline for the different scan/design systems currently available in thedental market. It can also be appreciated that the crowns can befabricated by alternative means such as a more traditional waxing andcasting method. This enclosed process should only be considered asexemplary. In STEP 666, the dentist or technician will refine themargins 162 of the framework where the crowns will mate. Many times themanufacturing process used in creating the duplicate framework can leavetool marks or additional material in these small areas due tolimitations of tool size, access, or limitations of the manufacturingprocess itself. Using a hand piece and bur, the dentist or technicianwill remove any material left by the manufacturing process to create aclear and uniform margin 162 around the support post 164. Once themargins have been refined appropriately, the framework while positionedon stone cast 125 will be impressed utilizing an impression material 122and a second framework stone will be created with dental stone material126. These processes are noted as STEPS 668 and 620 in Flowchart 600.The dentist or technician will section the stone support posts from oneanother by splitting the framework stone into multiple individual dies.The individual support post dies will be separately scanned toaccurately capture the margin where the crown will mate to theframework. The support post dies will be scanned together and a stonecast of the opposing arch will be scanned in an appropriate orientationrelative to the support post formations. These scan sets will beappropriately aligned relative to one another. A crown for each supportpost will be designed virtually. This process can take considerable timefor the dentist or technician in creating the individual support postdies, scanning each one, and then in turn designing an appropriatecrown. Once the virtual models of the crowns are complete, the modelsare typically loaded into a mill where the crowns are manufactured outof an appropriate material such as zirconia, titanium, semi-preciousmetal, lithium disilicate, plastic, PMMA, acrylic, resin ceramic(Lava-Ultimate, Vita-Enamic), etc. . . . The crowns can also bemanufactured by means of additional manufacturing processes, such as 3Dprinting, laser sintering, ceramic pressing, EDM, etc. . . . Once all ofthe crowns 170 have been fabricated their fit is assessed against themargin 162 and support posts 164 of duplicate framework 168, as noted inSTEP 628. Many times the technician or dentists have to reduce or modifythe contours of the framework or crown in order to achieve theappropriate fit. If the fit is deemed unacceptable, the dentist ortechnician may need to attempt at refabricating the crown, which mayresult in creating a new impression of the framework and repeating thetasks associated with fabricating the necessary crowns, STEPS 668-628.These errors and reworks can be costly, time consuming and prevent thefinal prosthesis from being completed in a timely manner. When all ofthe crowns have been deemed to fit appropriately to the duplicateframework 168, the dentist or technician will check the occlusalcontacts of the crowns against the opposing dentition and modifyutilizing a hand piece and bur to reduce the occlusal contours andprovide the appropriate level of contact with the opposing arch. Agingival mask can be applied to the framework, which can be performed inseveral ways either by processing pink acrylic, stacking compositematerials, or applying porcelain onto the duplicate framework 168. Theseprocesses are commonly known in the dental industry and will not becovered in great detail here in this application. Finally the dentist isready to deliver the duplicate framework with the gingival mask andcement the crowns 170 onto the framework in the patient's mouth.

If the framework design was indicated for a traditional hybrid design,the technician will not perform all the STEPS outlined in FIG. 11A. FIG.11B provides a list of reduced steps that excludes the requirements fordesigning and fabricating the individual crowns. Also the dentist ortechnician will not be required to include or refine the margins or thesupport posts as previously discussed. Once the framework has beenfabricated, the dentist or technician will begin to set the dentureteeth to the framework as noted in STEP 714. Many times the underside ofthe denture teeth have to be reduced or modified in order to becorrectly positioned relative to the bar and the opposing dentition andin order to create room for the acrylic that will be processed. Theremay also be times when the fabricated framework is reduced rather thanthe denture tooth. The dentist and technician have to be careful inperforming these modifications. If the lower acrylic portion of thedenture teeth are reduced significantly, the processed acrylic will notbe able to bond appropriately to the denture teeth and the denture teethcan break free from the acrylic when occlusal loads are distributed ontothe prosthesis. If the framework is reduced significantly, themechanical strength of the framework can be compromised and theframework will begin to flex during occlusal loading potentially leadingto the framework and/or acrylic breaking. Once the

Denture teeth have been properly set, the dentist or technician willprocess the acrylic through a commonly known method (injection, packing,pour, VLC-visible light cured, heat cured, cold cure). The dentist ortechnician will refine and polish the processed acrylic and deliver thefinished restoration to the patient.

In addition to duplicating an acrylic model 166 of the framework, thedentist or technician can utilize a process as outlined in U.S. Pat. No.8,100,692, where the framework is digitally design on the basis on thesoft tissue contours of stone cast 125 and position of the denture teethand gingiva contours of diagnostic wax up 130. This process alleviatesthe need for an acrylic model and provides for an improved design inknowing the position of the buccal and lingual boundaries of theprosthesis. However this process cannot guarantee that the denture teethor framework will not need to be modified prior to processing theacrylic or prevent the potential breakages noted above.

In creating a dental prosthesis consisting of an implant frameworksupporting a series of crowns/bridges as outlined in application Ser.No. 14/272,566, the dentist and/or technician will create a stone cast125 and diagnostic wax-up 130 as previously discussed. It is from theseelements, where the invented process will allow for the simultaneousdesign and fabrication of the crowns and framework. First a digital scanof the stone cast 125 utilizing the alignment posts 156 attached to theanalogs 124 as detailed in application Ser. No. 11/875,826, isconducted. This process will determine the exact location of thecritical mating geometries and their correlation relative to one anotheras well as relative to the soft tissue contours captured in the stonecast. As demonstrated in FIG. 12A, in step 214 of the process, thedentist sends the stone cast 125 and diagnostic wax up 130 to thelaboratory. In step 216, the laboratory inserts alignment posts 156 intothe analogs 124 embedded in the stone cast 125. These alignment posts156 are configured to engage the mating surfaces of analogs 124 and holdthe alignment posts coaxial with the longitudinal axis of analogs 124.They may have differently shaped flat, frusto-conical and cylindricalsurfaces configured to engage with the mating surfaces of analogs 124.The alignment posts 156 used in this process have two spherical surfacescomprising centers coaxial with analog 124. These alignment posts neednot have spherical surface portions, but may have any predeterminedgeometric shape as deemed suited by the user. This process also enclosesthe use of a single gauge; however it can be appreciated that a seriesof gauges could be used instead of a single embodiment to achieve thesame result.

The mating surfaces on the alignment posts and the mating surfaces onthe analogs 124 inter engage to cause the alignment posts 156 to bealigned coaxial with analogs 124. The alignment posts 156 cover the freeends of the analogs 124 exposed in stone cast 125.

In step 218, once the alignment posts 156 have been attached to theanalogs 124, the scanner 182 is configured to scan the alignment postsand the soft tissue replica of the patient's mouth formed in the surfaceof the stone cast 125, and the alignment posts 156. The surfaces ofstone cast 125 that are scanned by scanner 182 include the surfaces ofthe stone cast that replicate the mucosal tissue in the patient's mouth.Scanner 182 stores in the memory of computer 186 a first point clouddataset of the stone cast 125 with alignment posts 156 attached. In step218, scanner 182 also scans the surface of diagnostic wax-up 130 and thesurface of stone cast 125 (preferably when they are assembled) and savesa second point cloud dataset collectively representing the scannedsurface of the diagnostic wax-up 130 and stone cast 125. Alternatively,the operator can scan the diagnostic wax-up 130 separately from thestone cast and later register the point cloud dataset of the stone cast125 and the diagnostic wax-up 130.

If the diagnostic wax up 130 is scanned on the stone cast 125, the scanpreferably includes data points taken from all the exposed externalsurfaces of the diagnostic wax-up 130 (i.e. the outwardly facingsurfaces that model the gum and the teeth) as well as surfaces of thestone cast 125 adjacent to the diagnostic wax-up 130. The surfaces ofthe stone cast 125 adjacent to the diagnostic wax-up that are scanned inthe second point cloud dataset are also preferably scanned in the firstpoint cloud dataset and thus there is some overlap in surface contoursin both the first and the second point cloud datasets—both datasetsinclude data points scanned from the same surfaces of stone cast 125.This permits later registration of the first and second point clouddatasets.

If the diagnostic wax-up 130 is scanned when it is separate from thestone cast 125, it is preferably scanned so that the second point clouddataset includes data points taken from all the exposed externalsurfaces of the diagnostic wax-up 130 (i.e. the outwardly facingsurfaces that model the gum and the teeth) as well as surfaces of thediagnostic wax-up 130 that would abut stone cast 125 if the diagnosticwax-up 130 was mounted on the stone cast. Since the diagnostic wax-up130 was formed by molding a plastic (or wax or acrylic) material to thesurface of the stone cast 125, the scanned surface contour of thediagnostic wax-up 130 that abut the stone cast are a mirror image ofsurface contours of the stone cast 125.

In the preferred embodiment these abutting stone cast 125 surfaces werescanned previously and are a part of the first point cloud dataset.Thus, the first and second point cloud datasets include a subset of datapoints taken from mirror image surface contours—surface contours commonto both the first and second point cloud datasets—common to thediagnostic wax-up 130 and to the stone cast 125. This permits laterregistration of the first and second point cloud datasets.

In step 220, computer 186 determines the location and orientation of thealignment posts as they are attached to analogs 124 in the stone cast125. Computer 186 sequentially selects a digital parameterized fitting152″ from its internal library and aligns the mating surface (orsurfaces) and axis of the selected digital parameterized fitting 152″with the surface (or surfaces) and axis of one of the analogs based upondatums derived from the alignment posts 156. Computer 186 repeats thisprocess for each additional analog 124 whose location and orientationwere determined in step 220, until it has built up an initial surfacemodel of dental framework 324.

In step 222, a surface model of the unique contours of stone cast 125 iscreated which is a representation of the soft tissue contours in thepatient's mouth. The stone cast surface model 320 will provide a lowerlimit to which the framework can be designed to.

In step 224, a surface model of the unique contours of diagnostic wax up130 is created which is a representation of the proposed prosthesis forthe patient. The diagnostic wax-up surface model 322 contains the uniquebuccal/facial and occlusal contours of the denture teeth 132. Thediagnostic wax-up surface model 322 will provide the necessaryinformation regarding the orientation of the individual denture teeth132 as they are positioned relative to one another within diagnosticwax-up 130. The diagnostic wax up surface model will also capture anyunique gingiva contours as designed by the dentist or technician.

The surface models 320 and 322 can be the raw point clouds derived fromthe scan data of the stone cast 125 and diagnostic wax-up 130 or can bea sheet body, where a surface has been wrapped across the raw pointclouds. These models can also be closed surface models, allowing forBoolean Unite and Subtract Operations to be performed utilizing thesemodels or other CAD bodies.

The two sets of scan data and resulting surface models of the stone cast125 and diagnostic wax-up 130 provide all of the necessary data fordetermining the position of the denture teeth 132 in diagnostic wax-up130 relative to the implants/abutments and the soft tissue contours ofstone cast 125 as well as defining the boundaries or limits in which theframework should be designed within. The scan data of the diagnostic waxup 130 will provide all of the necessary positional information fordetermining the correct orientation of the crowns and related supportposts (The term prep tooth forms or PTF can be used in place of the termsupport posts. Both prep tooth forms (PTF) and support posts aredescriptive of the portion of the framework that will mate with andsupport the crown.).

The framework is created through a novel concept in utilizing a libraryof crown models and prep tooth forms (support posts). The crown modelsare based upon known dimensions of standard tooth sizes. Many of thecurrent dental design software systems, such as Procera, 3Shape, orDental Wings, have a library of digital crown or tooth files based uponthese standard dimensions. Stock Denture Teeth are also constructed onthe basis of the standard tooth size and are commonly used in theconstruction of dentures, over-dentures, and fixed hybrid restorationsfor treatment of the edentulous patient. Also some of the previouslymentioned software systems include models of the denture teeth in theirlibrary. As discussed previously, these denture teeth 132 are commonlyused in the dental market and consist of known dimensions that have beenstandardized for mass production. By utilizing a non-contact or touchprobe scanner similar to the one described in FIG. 13, an operator cancapture the unique contours of the commonly available denture teeth 132that are used by the dentist or technician in creating the diagnosticwax up 130. FIGS. 14A-B show a model of the reverse engineered denturetooth and shows the unique occlusal contours 300 and buccal/facialcontours 302 captured during the scanning process. The scanning processwill also capture the intaglio surface 304 or underside of the denturetooth, which will enable for the creation of a denture tooth model 306.On the basis of the denture tooth model 306 and occlusal contours 300and buccal contours 302, a PTF 310 can be designed to optimally supporta crown that has the same or similar contours as the denture tooth. ThePrep Tooth Form or PTF 310 can be designed to accommodate an appropriatewall thickness of the crown and provide an ideal margin 162 where thecrown will mate with the framework. The crown model 312 consists mostlyof the contours of the reverse engineered denture tooth 132 captured indenture tooth model 306, but additional features or material can beadded to the crown model in generating an ideal mating surface that willinterface with the PTF or provide an ease in manufacturing. The addedlingual crown material 308 as shown in FIGS. 15A and 15B has beenincluded into the design to create a more planar mating surface ormargin 162 between the crown model 312 and PTF 310. However it can beappreciated that the mating surface or margin 162 can be non-planar andprovide a margin 162 that is more in line with one that the dentist ortechnician would find for a prepped tooth or custom abutment. Thelingual crown material 308 can be designed to aid during the gingivalmasking process. In this example, straight parallel walls have beenincluded into the design to improve the retention of the crowns afteracrylic processing. An appropriate cement gap 314 also has to bedesigned into the crown model 312 to provide the necessary space fordental cement that will allow for the crown to be fixated to theframework. The cement gap 314 will terminate at margin 162, where thecrown and framework will ultimately mate.

The crown model 312 can be designed in a parametric or non-parametricCAD body. In the non-parametric form, the crown model is a rigidduplicate of the denture tooth model 306. This non-parametric model doesnot provide the CAD Operator with an ability to easily modify thesurface or contours of the crown model 312. For a non-parametric CADbody, the operator will have to use Boolean and Trim functions to add orsubtract additional features in order to change the occlusal contours300 and buccal contours 302 of the crown model 312. In comparison theparametric CAD body can be constructed of a series of splines andsheets, possessing data points or poles, allowing for the CAD Operatorto modify or alter the surface of the crown model 312. The parametricCAD body allows for easy manipulation of the crown model surface toaccommodate any design requirements required by the dentist. One exampleof manipulating the crown model surface would be modifying the occlusalcontours of the crown. The dentist or technician may choose to lower orheighten all or portions of the occlusal surface to provide an idealocclusal relationship with the opposing arch. Another example would bemodifying the mesial/distal side contours in order to increase ordecrease the mesial/distal contacts between the crowns.

FIGS. 15A-F depict an exemplary crown model and PTF. FIGS. 15A-F depicta molar crown model 312 and PTF 310. For demonstration purposes thisapplication will only show the design of a crown model and PTF for amolar tooth. It can be appreciated that the PTF can be designed toproperly accommodate any size tooth, such as an incisor, cuspid, orpremolar. It can also be appreciated that any denture tooth system canbe incorporated though the disclosed process. There are also availablelibraries of stock crown CAD files, in many of the dental design systemsthat can be incorporated and utilized in addition to reverse engineeringthe stock denture teeth. The PTF 310 has been designed to properlysupport the cusp structure of the reverse engineered denture tooth andthe designed crown model 312. The design of the PTF 310 can also bemodified in any way deemed appropriate by the designer to meet therequests of the customer. The height and width of the PTF can be alteredto better deal with the restorative space presented with the case. Theenclosed PTF design has a much more flat and planar design associatedwith the margin 162. Other designs may utilize a much more natural rootform margin that comes up higher in the mesial/distal aspects of thecrown and lower in both the lingual/buccal aspects.

As demonstrated in FIGS. 15E-F the crown model and PTF can be combinedinto assembly 316 and share the exact coordinate system, allowing forthem to be aligned relative to one another in an ideal fashion. Assembly316 allows for the crown model 312 and PTF 310 to be readily importedand remain properly aligned relative to one another. However it can alsobe appreciated that the crown model 312 and PTF 310 can be importedseparately depending upon the CAD system or processes being implementedby the Operator. One example of importing PTF' s 310 without the crownfiles would be if the dentist or technician is planning on creatingcustom crowns for the final restoration. In this instance theutilization of the crown files may be completely unnecessary and theoperator can position PTF 310 in the ideal position to support thecrown. This exemplary process would also allow the technician to utilizeone of the other dental design software packages previously mentioned todesign and fabricate the crowns, in a similar fashion as through the“copymill” process.

FIGS. 15A-D show in closer detail crown model 312 aligned appropriatelyto PTF 310. As depicted in the figures the PTF 310 expands substantiallyto support the crown model 312 in the mesial distal aspect FIG. 15A andthe lingual facial aspect FIG. 15 B. FIGS. 15C and D are cross-sectionalviews of the crown model 312 and PTF 310 showing the cement gap 314 andmargin 162 where the crown intimately mates with the PTF. The cement gap314 and margin 162 can be adjusted by the designer to meet the customerrequirements or to better suit the preferred manufacturing process.FIGS. 15A-F show the ideal orientation of the crown model and PTF.

However there are instances when this orientation may not be ideal due adesign requirement for a particular case. The crown model and PTF canhave a series of dependent features that when a change in the feature ofone body is performed, the second dependent body will automaticallyupdate based upon this change. One example would be repositioning theheight of the PTF. As demonstrated in FIG. 15G, when the PTF ispositioned higher relative to the crown model 312, the cement gap 314and margin 162 will automatically update to accommodate for this newposition. The crown model 312 and PTF 310 can also be allowed to bepositioned in different orientations relative to one another andsimilarly update on these new positions. Another example as demonstratedin FIG. 15H would be repositioning the angle of the PTF due to an issueof path of insertion or tool access for manufacturing. As shown in FIG.15H, when the PTF is aligned to the new position not only does thecement gap 314 update, but also margin 162 will update to this newalignment. This dependency provides the ability for the designer to makesimple modifications in a timely fashion when designing the framework inaccommodating a design request for a customer or allowing for an ease inmanufacturing.

The crown/PTF assembly 316 can possess additional sub features inaddition to the full contour crown surface. The crown model can havesubtract features which will provide the technician and dentist with astandard coping or cutback coping that would be ideal in stackingporcelain. The standard coping or cutback coping can be included throughthe use of a Boolean Subtract Feature or as a separate CAD body withinthe Crown/PTF assembly 316. The inclusion of these features provides abroad spectrum of restorative elements for the dentist or technician tochoose from.

In step 226 of FIG. 12, the Crown/PTF assembly 316 is imported andaligned relative to the diagnostic wax-up surface model 322. Thecrown/PTF assembly 316 will have the same surface contours as one of thedenture teeth 132 that was incorporated into diagnostic wax up 130.Utilizing a best fit operation, the crown/PTF assembly 316 will beproperly positioned on the basis of the facial/buccal and occlusalcontours for the specific denture tooth 132. FIGS. 16A-B demonstratethis process. In FIG. 16A, a molar crown/PTF assembly 316 is alignedappropriately to diagnostic wax-up surface model 322. In FIG. 16B, theadditional crown/PTF assemblies are aligned for the incisors, cuspids,premolars, and remaining molar. This alignment process can be carriedout by computer 186 automatically or overseen and performed manually bythe operator.

In Step 228, the Operator will review and adjust the position of thePTF's 310 to best accommodate the aesthetic and functional demands forthe case. As discussed above, this process of moving the PTF's 310 canalso accommodate for improved tool access on the basis of themanufacturing method. Once appropriately positioned into the properorientation, the cement gap 314 and margin 162 will automatically updateon the basis of this new position. FIG. 17 shows all of the PTF's 310 inthere appropriate position, while the crown models 312 and diagnosticwax-up surface model 322 are hidden. FIG. 18 shows the PTF's 310 andDPF's 152″ properly positioned relative to one another. In step 230, thecomputer 186 is configured to generate a surface model of bridgingstructure 154′ (FIGS. 19A-B) that will join PTF's 310 and the digitalparameterized fittings 152″. This includes the computer 186 determiningthe cross-sectional shape, length and location of the bridgingstructures as described below. This surface model of this bridgingstructure 154′ extends between and joins PTF's 310 and the digitalparameterized fittings 152″ and thereby completes the surface model ofthe dental framework 324. Bridging structure 154′ also comprises theportions 155 that extend away from the end digital parameterizedfittings 152″ and are supported only at one end. One form of thebridging structure is shown in FIGS. 19A-B as a simple elongated memberhaving a predetermined cross section.

To generate bridging structure 154′, computer 186 determines the shape,length, and location of the individual portions of the bridgingstructure to attach PTF's 310 and digital parameterized fittings 152″.It is further configured to determine the shape length and location suchthat the individual portions will not intersect the stone cast surfacemodel 320. Since the surface of the stone cast 125 represents theexposed surfaces (including mucosal tissue) in the patient's mouth, thisreduces the likelihood that the physical framework created from thesurface model will contact and damage the patient's mucosal tissue.Computer 186 is configured to provide a separation distance between thesurface model of the stone cast and the bridging structures. In onearrangement the computer 186 is configured to place the bridgingstructures a predetermined minimum distance from the surface model ofthe stone cast. In another arrangement the computer is configured topermit the operator to select a desired minimum distance between thebridging structure and the stone cast surface model 320. In anotherarrangement, the computer is configured to offer to and/or accept fromthe operator only a certain range or number of minimum separationdistances, such minimum separation distances preferably ranging between0.1 mm and 5 mm.

Computer 186 is configured to create the bridging structure by providinga pre-designed list of bridging structure forms (e.g., a cylinder,circle, ellipse, square, polygon or other geometric shape) that havebeen previously stored in the electronic memory of the computer. In oneconfiguration, the computer is configured to automatically select thecross sectional dimensions of each form (diameter, radius, major andminor diameter, height, width, etc.). In another configuration thecomputer is configured to present the user with a list of pre-set valuesor defined by the user among which the user can select preferreddimensions. In yet another configuration, the computer is configured toprompt the user to enter specific numeric values for these dimensions.The form of the bridging structures can also be defined by the user.

Computer 186 is configured to determine the proper location of thebridging structure 154′ extending between the PTF's 310 and the digitalparameterized fittings 152″ by locating the beginning and end of eachstructure according to position information that is derived from thescanned point cloud dataset of the alignment posts. Position of thebridging structure can also be determined by the operator or from thepoint cloud data set of the stone cast and/or diagnostic wax up.

In another arrangement, the computer 186 is configured to determine thelocation of the bridging structure 154′ extending from each of the PTF's310 and digital parameterized fittings 152″ by locating the beginningand end of each structure according to reference points and axesassigned to the digital parameterized fittings 152″ by the computerprogram from a list of pre-set values or defined by the user. Forexample, each PTF 310 and digital parameterized fitting 152″ which isplaced in the model may have only certain types of bridging structuresto which they can be connected, and may only connect to those bridgingstructures at certain locations on the PTF or digital parameterizedfitting. This information is stored in the electronic memory of computer186 in association with each PTF or digital parameterized fitting. Whena particular PTF or fitting is inserted into the model, computer 186 isconfigured to the type and location information associated with theinserted PTF or fitting and locate (or permit the operator to locate)bridging structures of the type and at the locations compatible withthose PTF's or fittings. This process can also ensure the bridgingstructure does not extend into critical mating areas of PTF 310 anddigitally parameterized fitting 152″ that would affect the potential fitof the crowns or implant/abutments to the framework. In the case ofdistal extensions 155, computer 186 is configured to cantilever them offthe digital parameterized fittings 152″ and extend them distally alongthe arch of the patient's mouth. These distal extensions 155 arepreferably 20 mm in overall length or less. They are also selected asdescribed above.

Computer 186 is configured to conduct a mechanical design analysis ofthe distal extensions 155 that validates shear and bending strengthlimits for those geometries relative to their chosen material andshapes. Computer 186 is configured to apply the appropriate shear,tensile and compressive stress analysis techniques to the chosengeometries automatically or from a pre-determined list of tests chosenby the user. Upon successful analysis of the distal extension designs,the extensions are verified or accepted by the user.

As part of the step of generating the bridging structure 154′ computer186 is configured to determine a location for the bridging structure154′ that will not intersect the diagnostic wax-up surface model 322.This ensures that the bridging structure 154′ of the final dentureframework will not stick through, but will be disposed within, the bodyof the diagnostic wax-up 130.

It can be appreciated that all of the disclosed steps being performed bycomputer 186 can be performed manually by the Operator. The Operator canalso determine the use of any number of custom geometries or series ofgeometries to be used for the bridging structure 154′ and distalextensions 155.

Upon completion of the bridging structures 154′ and distal extensions155, the final surface model of the framework 324 is complete. The finalsurface model of the framework will consist of PTF's 310, DPF's 152″,bridging structures 154′ and distal extensions 155. FIGS. 19A-B show thefinal surface model of the framework 324. Computer 186 will alsodetermine any interference between the crown models 312 and the surfacemodel of the framework 324 that may have been generated during thedesign process.

In STEP 232, computer 186 will finalize the surface model of theframework and crowns by alleviating any interference between thesesurface models. This process is performed through a Boolean subtractionof the surface model of the framework 324 from crown models 312. FIGS.20A-B show the crown models 312 and surface model of the framework 324appropriately positioned relative to one another. At this time theOperator can also choose to include screw access holes into the crownmodels 312 at the request of the dentist or technician.

There also may be times when the dentist or technician may prefer thecrown models 312 be adjoined to one another into a bridge due to designlimitations associated with the case, such as the position of a screwaccess hole or limited vertical space, or to meet a personal preferenceof the dentist. In FIG. 21, crown models 312 have been adjoined to oneanother in creating bridge model 350. Through a Boolean Union or theaddition of other CAD features herein referred to as bridge bodies 352,the crowns 312 can be adjoined to one another as best determined by theOperator and can include all of the crowns or as few as two. In FIG. 21five crown models have been combined into forming bridge model 350 bymeans of bridge bodies 352. Bridge bodies 352 can consist of astandardized profile (e.g., a cylinder, circle, ellipse, square, polygonor other geometric shape) or the Operator can custom design anappropriate structure to provide the appropriate mechanical strength toresist against the occlusal forces of the patient's bite. If necessarythe Operator can add appropriate features or geometries to ensure thebridging structure will properly mate to the framework and functionunder the occlusal loads of the patient. At times the creation ofbridges or adjoining the crowns may be necessary due to the position ofa screw access hole that would significantly reduce the size of a PTF310 to a point where it would not be able to properly support a crown byitself. In this instance bridging the crown in this area to one or bothadjacent crowns would prevent it from becoming damaged or dislodged whenplaced under occlusal loads by the patient.

The operator may also determine it be best for the PTF's 310 be linkedto one another in creating a larger support post geometry to support theoverlying bridge. In the same manner that the bridging structures 154′are extended between the PTF's 310 and digitally parameterized fittings152″, a PTF bridging structure can be incorporated into the designeither automatically by computer 186 or manually by the operator. ThisPTF bridging structure can consist of a standardized profile (e.g., acylinder, circle, ellipse, square, polygon or other geometric shape) orthe Operator can custom design an appropriate structure based upon thepatients clinical conditions. The PTF bridging structure can have aconstant cross-section or allow for portions of the PTF bridgingstructure to taper in from the buccal/lingual aspects to provideadditional anti-rotation features when the overlying crowns or bridgesare positioned on them appropriately. FIG. 22 shows a portion offramework model 324 with a PTF Bridging Structure 354 that has beencreated to support bridge 350. The PTF bridging structure extends acrossdigitally parameterized fitting 152″ in order to provide the necessarysupport for bridge 350. Due to the position of digitally parameterizedfittings 152″ and the resulting screw access holes, the standard PTF'swere reduced drastically requiring for the creation of bridge 350 andthe PTF bridging structure 354. FIG. 23A-B show framework model 324 withbridge 350 properly positioned to one another.

It is also at this time that the Operator can choose to combine portionsor the majority of the diagnostic wax-up surface model 322 to the crownsand/or bridge, to ensure the gingiva contours are included in thedesign. This process may be advantageous where there is limited verticalspace associated with the patient. In having the gingiva contoursincorporated into the design, the operator can ensure the gingiva willhave substantial strength characteristics as it is joined and fabricatedfrom the same material as the crown or bridge. In the case of a fullZirconia restoration, the technician can apply coloring through stainsand dyes in order to create the aesthetics for both the gingiva andcrown portions. In addition to combining portions of the diagnostic waxup to the crowns in creating the gingival structures, the operator canchoose to design custom gingiva features onto the crown utilizing thetools in the design software. This process would allow the operator tomodify the contours to best meet the clinical demands of the case or toprovide the best foundation for the finishing processes to be performedafter the crown/bridge with gingiva has been fabricated. One examplewould be in the creation of gingival contours that would be ideal forporcelain stacking. Rather than having the exact contours of thediagnostic wax-up surface model 322, the preferred geometry may be thecreation of a small shelf with the buccal aspect of the gingiva contourreduced slightly to accommodate the added thickness of the porcelain.The Operator could determine the appropriate dimension for the necessaryporcelain, for example 1-2 mm, and create the appropriate trim orBoolean subtraction to reduce the gingiva contour from the diagnosticwax-up surface model 322 or custom design the appropriate gingivaconstruct manually using the CAD tools provided in the software.

In STEP 234, tool paths are generated for the surface model of theframework 324, crown models 312 and/or bridges 350. Since theorientation and position of the framework and crowns has been determinedalong with the orientation and position of the DPF's 152″ and margins162 (where the crowns mate to the framework), both the framework andcrowns can be manufactured simultaneously in the chosen material(titanium, cobalt chrome, zirconia, wax, plastic, composites, acrylic,lithium disilicate, plastic, PMMA, resin ceramic (Lava-Ultimate,Vita-Enamic) etc. . . . ) and through the preferred manufacturingprocess (milling, laser sintering, 3D printing, EDM, etc. . . . ).

Once the framework and crowns have been manufactured, they are deliveredto the dentist and/or technician for the creation of the gingivacontours. The gingiva contours can be created by applying acrylic,composites, porcelain, or any other preferable dental material to theframework. If the gingiva contours were included in the design of thecrowns, the technician will perform the necessary processing (i.e.staining, coloring, stacking porcelain, adding acrylic or composite . .. ) to complete the gingiva aesthetics.

The above disclosed invented process utilizes a traditional diagnosticwax-up 130, which provided the position of denture teeth 132 andultimately PTF's 310 and crown models 312. In the first alternateembodiment of the process outlined in application Ser. No. 14/272,566,the use of a virtual set up is used in place of the diagnostic wax-up130. There are currently multiple dental systems and software (such as3Shape, Dental Wings, Avadent and Procera) which have the ability to layin CAD models of denture teeth or stock teeth relative to scans of astone cast and an opposing dentition. For this first alternate process,the stone cast and opposing cast would be scanned separately and thenscanned in their proper orientation relative to one another. Utilizingthe scan capturing the orientation of the stone cast and opposing cast,the scan data of the stone cast and opposing cast will be properlyaligned to one another. Once properly aligned, the Operator willposition the CAD models of the denture teeth or stock teeth relative tothe occlusion of the opposing cast. Once the position of the CAD modelsof the denture teeth or stock teeth have been finalized, thisinformation can be used in aligning the crown and PTF assemblies 316 andbegin designing the crowns and framework. In addition to utilizing theCAD models of the denture teeth or stock teeth, the operator canimmediately begin utilizing the library of crown and PTF assemblies 316and align the assemblies relative to the opposing cast for the properorientation. This process may be advantageous over the previousdescribed process as it alleviates the dentist and/or technician fromhaving to create the diagnostic wax up. Also if the crown models aretruly parametric, the operator can modify the design of the occlusalcontours and buccal contours of the desired crown to meet any uniquedesign requirements for the dentist.

In the second alternate process outlined in application Ser. No.14/272,566, the scanning process for capturing the implant and abutmentpositions is altered by the use of an intra-oral scanner that woulddirectly capture the implant and/or abutment locations in the patient'smouth along with the gingiva contours. The intra-oral scanner can alsocapture the contours of a diagnostic wax up that has been placed in thepatient's mouth or the position and orientation of the opposing archduring the scanning process. From this digital data, the dentist ortechnician can identify the appropriate location of the crown/PTFassemblies 316 and digitally parameterized fittings 152″. This processwould alleviate the dentist or technician from being required to createan impression or stone cast.

In a third alternate process outlined in application Ser. No.14/272,566, the dentist or technician can utilize a CT scan or series ofCT scans for the basis of determining the appropriate position of thecrown/PTF assemblies 316 and the digitally parameterized fittings 152″.The dentist or technician can use the CT scan data for determining orplanning the position of the implant locations and ultimately theposition of the digitally parameterized fittings 152″. The use of aradiographic stent demonstrating the ideal tooth position for therestoration can also be included in this process and provide the dentistand technician with an ability to align the crown/PTF assemblies 316relative to the contours of the radiographic stent or relative to theposition of the opposing arch. The dentist or technician could alsoutilize a CT scan of the patient's previous existing dentition, whichcould be aligned utilizing anatomical markers, in order to determine theideal position of the crown/PTF assemblies 316.

These alternate embodiments only demonstrate some of the potentialoptions in combining different digital data acquisition protocols intothe invented process. As can be appreciated, these are only a handful ofpotential embodiments of the invented process, but should provideinsight as to the adaptation of future technologies.

The above descriptions, alternate embodiments and processes describedand outlined in application Ser. No. 14/272,566 can be appreciated forits ability in providing an improved functional and aestheticrestoration for cases with large vertical dimensions. For patientsexhibiting a much smaller vertical dimension (less than 10 mm), thefunctional or aesthetic characteristics of the resulting restoration maynot be ideal. We have already discussed the issues surroundingtraditional hybrid designed prosthesis utilizing denture teeth andprocessed acrylic in reduced vertical dimensions where acrylic breakageis a common problem. For Individual crown type restorations, the issueof reduced vertical dimensions provides a unique challenge where thedesigner does not have the appropriate space for the fabrication of theindividual support post or PTF's and providing crowns with anappropriate wall thickness to prevent breakage. An additional concern inreducing the wall thickness of the crowns is the potential show throughof the underlying support post, which may affect the shade of theprosthesis. The proposed invention is to provide an improved prosthesisand process over any of the previously described in dealing with reducedvertical dimensions.

The preferred embodiment of the invention consists of a frameworkfabricated form a dental material (titanium, cobalt chrome,semi-precious metals, precious metals, zirconia, lithium disilicate,ceramic, PMMA, composite, plastic, acrylic, wax, etc. . . . ) thatsupports a veneering overlay consisting of a second dental material(titanium, cobalt chrome, semi-precious metals, precious metals,zirconia, lithium disilicate, ceramic, PMMA, composite, plastic,acrylic, wax, etc. . . . ) FIG. 12B outlines the steps for designing andfabricating the preferred embodiment of the invention. Similar to theprocess outlined in Application 14/272,566, alignment posts 156 areattached to the analogs 124 of stone cast 125 and scanned where computer186 determines the location and orientation of the alignment posts andsequentially selects and aligns digital parameterized fitting 152″ basedupon datums derived from the alignment posts 156. Diagnostic wax-up 130is also scanned either properly positioned on stone cast 125 orseparately and then aligned to stone cast 125 utilizing the surfacecontour of the diagnostic wax-up 130 that abut the stone cast as theyare a mirror image of surface contours of the stone cast 125. When thediagnostic wax-up is scanned it is critical to capture the contours ofthe denture teeth and gingiva as these contours will be replicated inthe veneering overlay. Surface models of the stone cast (320) anddiagnostic wax-up (322) are generated on the basis of the scan data.These surface models are constructed in such a way as to allow forBoolean Unite, Subtract, and Trim Operations to be performed utilizingthese models or other CAD bodies. The above listed processes areoutlined in Steps 814-824 of FIG. 12B.

Once all of the scan data, surface models (320 and 322) and digitalparameterized fittings 152″ have been aligned properly to one another,computer 186 imports and appropriately aligns framework bridgingstructure 400 relative to the digital parameterized fittings 152″, stonecast surface model 320 and diagnostic wax-up surface model 322 as notedin STEP 826. This step can also be performed manually by the operator.The framework bridging structure 400 consists of a predefinedcross-section and possesses parametric attributes allowing for portionof the framework bridging structure to be adaptable to the uniquecontours of the diagnostic wax-up and stone cast surface models. In thepreferred embodiment the framework bridging structure consists of arectangular cross-section and can vary in height and length dependingupon the contours of the surface models 320 and 322. In some areas thebar may be taller than others due to the changes in the patient's softtissue that are captured in the stone cast surface model 320. In otherareas the bar may be wider than others due to the varying contours ofthe diagnostic wax-up surface model 322. Frequently the width of thediagnostic wax-up 130 is greater in the posterior regions, where themolar teeth reside in comparison to the anterior where you will find theincisors. Ideally the top surface of the framework will remain on asingle plane, but this top surface can be offset in certain areas due tofluctuations of the vertical dimension in the patient's mouth. This topsurface 402 will support and engage the resulting veneering overlay 404.The position and angulation of this top surface 402 can be adjustedautomatically by computer 186 or by the operator to meet either theclinical demands for the dentist and technician or for ease inmanufacturing. The position of this top surface 402 can be positionedsubstantially into the area where the denture teeth reside in thediagnostic wax-up 130. This design feature is possible as the veneeringoverlay 404 will be fabricated from a single monolithic piece. Thebuccal wall 410 of framework bridging structure 400 will be positionedideally 1-4 mm from the buccal aspect of the diagnostic wax-up surfacemodel 322. This required clearance allows for an appropriate amount ofmaterial to prevent any potential show through of the framework throughthe veneering overlay 404. The operator or computer will also adjust thebottom surface 403 of the bridging structure to have the appropriateclearance or contact with the gingiva contours as captured in the stonecast surface model 320. The stone cast surface model 320 can also beused as a Boolean CAD Tool to contour the bottom of the bar to matchgingiva contours in the patient's mouth by means of a Boolean Subtractoperation. In the preferred embodiment of the invention, the buccal wall410 is typically flat and held at a 90 degree angle relative to the topsurface 402. This design aspect provides an ease in milling andfabrication. Obviously this wall angle could be adjusted to meet thetechnical demands of the dentist or technician or due to a limitationassociated with the case. In the preferred embodiment, the lingual wall412 of the framework bridging structure 400 will be adjusted toterminate at the lingual boundary of the diagnostic wax-up surface model322 and can be flush with this boundary. The lingual wall 412 can beflat similar to the buccal wall 410 or even rounded if preferred by thedentist and/or technician. However using Boolean Unite, Subtract, andTrim Operations in the CAD software the lingual wall 412 can be shapedto exactly replicate the boundary of the diagnostic wax-up surface model322 and follow the exact lingual contours as created in diagnosticwax-up 130 by the dentist. FIG. 24A and 24B depict an embodiment of theframework 408. As demonstrated by these figures, digital parameterizedfittings 152″ has been united through a Boolean Unite Operation toframework bridging structure 400, as noted in Step 828. In thisembodiment, the digital parameterized fittings 152″ are substantiallywithin the body of the framework bridging structure 400. In someembodiments these digital parameterized fittings 152″ may extend throughor slightly out of the framework bridging structure 400.

As part of the framework bridging structure, one or more support posts406 can be positioned on top surface 402. Support posts 406 providemacro retention and resistance against lateral forces between theframework bridging structure 400 and the veneering overlay 404. Thesupport posts 406 can be imported as part of framework bridgingstructure 400 or imported separately. The preferred design of thesupport posts 406 is a design consistent with a cylinder, which can beeasily milled or fabricated by a known method (laser sintering, wireEDM, etc. . . . ), but can consist of any number of differentcross-sections as desired by the operator, e.g., a cylinder, circle,ellipse, square, polygon or other geometric shape. In addition to thesupport posts, the design can consist of slots or recesses on the buccalwall 410 or lingual wall 412. The combination of framework bridgingstructure 400, digital parameterized fittings 152″ and the associativeretention features (support posts 406 or other retention features)creates the complete embodiment of the dental implant framework 408.

As the framework bridging structure 400 is being designed, the veneeringoverlay 404 is being designed simultaneously. The veneering overlay 404is created directly from diagnostic surface model 322, by the use of aBoolean subtract operation and a unique subtract body related to theframework bridging structure 400. As discussed in application Ser. No.14/272,566 where the crowns, margins, and cement gaps are updated by therepositioning of the PTF or support post, the unique mating surface ofthe veneering overlay 404 is updated/refined by a unique subtract bodythat is dependent upon the design features of framework bridgingstructure 400 and digital parametrized fittings 152″ (top surface 402,support posts 406, buccal wall 410, lingual wall 412, slots, recessesetc.). The subtract body creates the necessary overlay mating surface402′ and the appropriate clearance gaps 414 that provide the necessaryspace and clearance between buccal wall 410, parameterized fittings152″, and protrusions 406. Clearance around the buccal wall 410,parameterized fittings 152″, and protrusions 406 allows for an intimatemating of the overlay mating surface 402′ to the top surface 402 of theframework bridging structure 400. This design aspect allows for anappropriate transfer of occlusal forces from the veneering overlay 404to the top surface 402 of framework bridging structure 400 andultimately to the dental implants in the patient's mouth. This clearancegap 414 also provides a space where a bonding agent such as cement,acrylic, heat cured bonding agent, chemical bonding agent (epoxy) can beused to permanently retain the veneering overlay 404 to framework 408.The subtract body for veneering overlay 404 can also include bodies forthe parameterized fittings 152″ and screw access holes 418 to besubtracted from the veneering overlay 404. This design feature allowsfor the dentist to access the screws retaining the framework to theimplants without having to remove the cemented veneering overlay 404.However at times the dentist may choose to bond the veneering overlay404 in the patient's mouth either due to aesthetic demand or issue witha screw access hole coming through a buccal aspect of the prosthesis.The previous description describes a design where the veneering overlay404 is retained to framework 408 by means of a bonding agent, which isthe preferred method. Bonding agents, such as cement, allow for therestoration to work in the smallest restorative spaces possible andpermanently fixates the veneering overlay to the framework, which allowsfor the most optimal performance of the restoration in the patient'smouth. It is obvious that other means of retention such as the use ofscrews, mechanical clamps, or memory alloy clamps (U.S. Pat. No.8,678,822) could also be used in retaining the overlay to the frameworkif space allows, but these mechanical retention means can deteriorateover time and be costly in replacing. If a mechanical retention means isused, the dentist or technician would still want to apply a material(silicone) that would seal the clearance gap between the veneeringoverlay 404 and framework 408.

FIG. 25A, B, C, D and E depict the preferred embodiment of the inventionas described above and demonstrates the framework bridging structure400, veneering overlay 404, the mating surface 402′, top surface 402,support posts 406, buccal wall 410, lingual wall 412 and clearance gap414. FIGS. 25D and E are cross-sectional views of the framework 408 andveneering overlay 404 and demonstrate the areas where clearance gap 414are positioned relative to the two parts. In the preferred embodimentdepict in these figures, the lingual wall of the framework is exposed.This feature is aimed in simplifying the operations associated withfabricating the framework and veneering overlay. The lingual wall 412and the bottom surface 403 of the framework 408 may be polished and leftexposed or the technician may choose to apply a dental material such ascomposite or acrylic to wrap and seal these surfaces. Some doctorsprefer this type of design as it allows them to adjust or add to thissurface as the patient's gingiva contours may change over time. Thisadditional work can be done at the same time that any other requiredfinishing steps are performed prior to delivering the restoration to thepatient's mouth. The design of the veneering overlay 404 can also bealtered by covering the lingual wall 412. The unique subtract body wouldneed to be slightly altered to accommodate this design feature increating the appropriate clearance between the lingual wall 412 andveneering overlay 404.

In addition to cementing the veneering overlay 404 in the patient'smouth to avoid the poor aesthetics, a “prep tooth form” or “PTF” can bedesigned into the framework bridging structure or into the veneeringoverlay to support a single crown, veneer or bridge to cover the screwaccess hole. FIGS. 26A, B, and C depict a crown 420 being placed onto aPTF 422 that is part of the framework bridge structure 400. In FIGS. 26Dand E demonstrates a crown being supported by a PTF 422 that is part ofthe veneering overlay 404. One benefit in designing PTF 422 as part ofveneering overlay 404 is crown 420 and veneering overlay 404 can befabricated from similar materials, such as Zirconia and allow for animproved shade match. In a similar fashion as discussed in patentapplication Ser. No. 14/272,566, the crown/PTF Assembly can be alignedrelative to the contours of the diagnostic wax-up surface model 322.Once properly positioned, the PTF 422 and spacing/cement gap for thecrown, veneer, or bridge in the veneering overlay 404 can be created byusing Boolean Unite, Subtract, and Trim Operations in the CAD software.This process does not have to be limited to just areas where there is anissue with the screw access hole. This operation or design can beconducted throughout the entire prosthesis and allow for the utilizationof different dental materials on the basis of the patient's clinicaldemands or doctor's preferences.

As previously mentioned, the veneering overlay 404 is created from thediagnostic wax up surface model 322 which captured all of the surfacecharacteristics of the teeth and gingiva contours of diagnostic wax up130. These contours can be left intact and the operator or techniciancan use a series of stains to color these contours to the appropriateshade per the material that the veneering overlay is fabricated from.However the veneering overlay 404 can be further refined to allow foradditional laboratory processing such as the application of porcelain,composite, acrylics, or other dental materials to aid in the aestheticsof the final prosthesis. Additional Boolean or offset operations can beperformed to the surface contours of the teeth or gingiva in theveneering overlay 404 to create a cutback 416 allowing for theappropriate support structure and space for these materials to beapplied post fabrication. This process allows the laboratory technicianto have a higher level of control on the look, shade and aesthetics ofthe final prosthesis. This process can also be performed on the toothaspect of the overlay, again allowing for the technician to applyporcelains, composites, acrylics, or other dental materials to aid orimprove the aesthetics of the final prosthesis. FIGS. 25A-E and 26A-Edemonstrate a cutback for the gingiva only. It is obvious to one trainedin the art, that a similar cutback could be performed to the toothportions of the veneering overlay 404.

Once the surface models for both the Framework 408 and veneering overlay404 have been finalized as noted in Step 832 the appropriate tool pathscan be generated (Step 834) for the simultaneous manufacturing (Step836) of both items. For fabrication purposes, one can choose from anumber of different methodologies such as but not limited to milling,laser sintering, 3D printing, ceramic pressing, EDM, etc. . . . Theframework and veneering overlay can also be manufactured from a numberof materials such as but not limited to titanium, cobalt chrome,semi-precious metals, precious metals, zirconia, wax, plastic,composites, acrylic, PMMA, resin ceramic (Lava-Ultimate, Vita-Enamic)etc. . . . Once the framework 408 and veneering overlay 404 have beenmanufactured, the operator can perform any of the necessary finishingactivities and attach the veneering overlay to the framework by means ofa bonding agent or other means of retention. In addition, the veneeringoverlay 404 may be manufactured directly to framework 408. In oneexample the Veneering Overlay can be printed directly onto the frameworkin the appropriately selected materials. A second example would be firstmilling the Veneering overlay in a wax material and then through the useof a lost wax technique, the veneering overlay portion can be castdirectly to the framework. Obviously these process would involveadditional work to refine the aesthetics before delivering to thepatient's mouth.

In the first alternate embodiment of the invented process, the use of avirtual set up in place of the diagnostic wax-up 130. There arecurrently multiple dental systems and software (such as 3Shape, DentalWings, Avadent, Ivoclar and Procera) which have the ability to lay inCAD models of denture teeth or stock teeth relative to scans of a stonecast and an opposing dentition. For this first alternate process, thestone cast and opposing cast would be scanned separately and thenscanned in their proper orientation relative to one another. Utilizingthe scan capturing the orientation of the stone cast and opposing cast,the scan data of the stone cast and opposing cast will be properlyaligned to one another. Once properly aligned, the Operator willposition the CAD models of the denture teeth or stock teeth relative tothe occlusion of the opposing cast or anatomical markers found on thecasts. The operator can also adjust the occlusion by tools provided inthe software. Once these CAD models have been properly positioned, thegingiva contours of the prosthesis can be constructed. This resultingmodel can be used in the same fashion as the diagnostic wax-up surfacemodel 322 in the above described process and provide the tooth andgingiva contours for the veneering overlay 404. The software programsalso have tools that would allow for the appropriate design orconstruction of a gingiva or tooth cutback design allowing for theapplication of acrylic, composites, porcelain or other dental materialto improve the aesthetics of the case.

In the second alternate process, the scanning process for capturing theimplant and abutment positions is altered by the use of an intra-oralscanner that would directly capture the implant and/or abutmentlocations in the patient's mouth along with the gingiva contours. Theintra-oral scanner can also capture the contours of a diagnostic wax upthat has been placed in the patient's mouth or the position andorientation of the opposing arch during the scanning process. From thisdigital data, the dentist or technician can identify the appropriatelocation of the digitally parameterized fittings 152″ and generate thestone cast surface model 320 and the diagnostic wax-up surface model322. This process would alleviate the dentist or technician from beingrequired to create an impression or stone cast.

In a third alternate process, the dentist or technician can utilize a CTscan or series of CT scans for the basis of determining the appropriateposition of the digitally parameterized fittings 152″. The dentist ortechnician can use the CT scan data for determining or planning theposition of the implant locations and ultimately the position of thedigitally parameterized fittings 152″. The use of a radiographic stentdemonstrating the ideal tooth position for the restoration can also beincluded in this process and provide the dentist and technician with anability to create the diagnostic wax-up surface model 322 relative tothe contours of the radiographic stent or create a virtual set uprelative to the position of the opposing arch. The dentist or techniciancould also utilize a CT scan of the patient's previous existingdentition, which could be aligned utilizing anatomical markers, in orderto create the diagnostic wax-up surface model 322.

These alternate embodiments only demonstrate some of the potentialoptions in combining different digital data acquisition protocols intothe invented process. As can be appreciated, these are only a handful ofpotential embodiments of the invented process, but should provideinsight as to the adaptation of future technologies.

What is claimed:
 1. A unique subtract body intended to create the matingsurface for a veneering overlay and a dental implant frameworkcomprising: dimensions dependent upon the design features of the dentalimplant framework; where some dimensions of the unique CAD subtract bodyare used in creating the mating surface for the veneering overlay tomate with the dental implant framework; where some dimensions of theunique CAD subtract body are used in creating clearance gaps between theveneering overlay and dental implant framework; where the unique CADsubtract body is parametric; and where the design of the veneeringoverlay and dental implant framework is determined from digital datadefining the appropriate tooth contours, gingiva contours and implantlocations for the dental prosthesis.
 2. The unique CAD subtract body ofclaim 1, where in the digital data for the design of the veneeringoverlay and dental implant framework have been derived from one of thefollowing scanning a diagnostic wax up or denture tooth set up; CADmodels in a virtual set up; an intraoral scan of a diagnostic wax up ordenture tooth set up taken in the patient's mouth; a CT scan or seriesof CT scans of the patient's mouth; a CT scan or series of CT scans withthe use of a radiographic stent in the patient's mouth.
 3. The uniqueCAD subtract body of claim 1, where the veneering overlay is intended tointimately mate to at least one surface of the framework.
 4. The uniqueCAD subtract body of claim 1, where the veneering overlay and dentalimplant framework can be manufactured simultaneously.